EMANZ EnergyMasters Accreditation Scheme

Application for Accreditation as an EnergyMasters Continuous Commissioning for Commercial Buildings

Specialist

Please refer to the EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Applicant’s Guide before completing this Application Form.

1. Applicant DetailsSurname: ___________________________ First name: __________________________

Address: ________________________________________________________________

___________________________________________Post Code: ___________________

Email address: ___________________________________________________________

Daytime telephone number(s): ______________________________________________

Company: _______________________________________________________________

Address: ________________________________________________________________

___________________________________________Post Code: ___________________

2. Qualifying StatusTick which set of eligibility requirements for qualifications and/or experience you meet below: 1. Have a 3, 4 or 5 year degree from an accredited university or college in science,

engineering or a related field, plus 5 years of verified experience in commercial building or facilities management involving the installation, testing/adjusting/balancing and commissioning, maintenance or servicing of HVAC or building management systems or control systems; OR

2. Have a 2-3 year trade certificate from an accredited university or college or a certified apprenticeship involving engineering or electrical or air conditioning disciplines, plus 7 years of verified experience in commercial building or facilities management involving the installation, testing/adjusting/balancing and commissioning, maintenance or servicing of HVAC or building management systems or control systems; OR

3. Have 10 years of verified experience in commercial building or facilities management involving the installation, testing/adjusting/balancing and commissioning, maintenance or servicing of HVAC or building management systems or control systems.

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014

EMANZ EnergyMasters Accreditation Scheme

3. QualificationsList in chronological order the courses or qualifications completed relevant to this Accreditation

Qualification Received

Length of study (years

from - to)

Field or Discipline in which

qualification issued

Education provider Year completed

4. Work History/Experience SummaryPlease complete the following in chronological order, describing the work done by you in each of your roles relevant to this Accreditation

Dates Month & Year, From – To

Organisation/ Employer Name and Location

Title or Position

Concise statements of key activities, responsibilities, major achievements and details of projects undertaken

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014

EMANZ EnergyMasters Accreditation Scheme

Dates From – To, Month & Year

Organisation/ Employer Name and Location

Title or Position

Concise statements of key activities, responsibilities, major achievements and details of projects undertaken

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014

EMANZ EnergyMasters Accreditation Scheme

5. Memberships/Registrations/Licenses

Organisation Class Current Y/N

Registration number Year gained

e.g. IPENZ TIPENZ Y 12345 1990

6. RefereePlease provide the name of one referee:

Referee’s name: _______________________________ Email: _______________________

The referee needs to be sufficiently familiar with the applicant’s work to provide comment on the applicant’s competence with regard to continuous commissioning of commercial buildings.

Applicants must forward the Referee Form to the nominated referee, along with a copy of the applicant’s completed Competency Self Assessment Form, for the referee to complete and then return directly to EMANZ.

7. Information for Accreditation ListingA successful candidate for accreditation will have the details of their areas of expertise listed alongside their name and contact details on the EMANZ website. Potential clients often want to engage EnergyMasters with particular experience or industrial machinery backgrounds. To assist the appropriate promotion of EnergyMasters please provide the following information.

Please provide no more than 200 words to outline your Areas of Expertise and gives details of the following:

Areas of Expertise and Experience

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014

EMANZ EnergyMasters Accreditation Scheme

Work Areas[Indicate here which geographical area of the country are you available to work in, for example, Lower North Island / National / South Island only].

8. Certified CorrectI ___________________________________ (full name), having completed the above to the best of my ability, hereby apply for Accreditation as an EnergyMasters Continuous Commissioning for Commercial Buildings Specialist. I also certify that the information provided here is correct and agree to indemnify and hold harmless EMANZ, their contractors, the CCCBS Board and those affiliated with EMANZ and its programmes.

Signed _______________________________________ Date ______________________

9. Privacy Any information you send to EMANZ will remain confidential and only be used inhouse for the purpose of this assessment.

10. Application Checklist

Please ensure that you have included the following documents as part of your application

No. of copies

Applicant Check

EMANZ Check

1 Application Checklist (this page) 1

2 Application Form (this form) 1

3 Competency Self Assessment Form 1

4 Completed Referee’s Form – from the nominated Referee (note: when completed, this is to be sent from the Referee directly to EMANZ)

1

5 Registered for the CCCBS Training Course and Exam NA

6 Paid for the CCCBS Training Course and Exam NA

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014

EMANZ EnergyMasters Accreditation Scheme

11. Processing this Application

Post or scan and email the completed forms to EMANZ for processing.

EnergyMasters Accreditation C/o EMANZPO Box 19-261Courtenay PlaceWellington 6149

Phone: 04 385 2839 Email: admin@emanz.org.nz Website: www.emanz.org.nz

EMANZ CCCBS Board Confirmation (EMANZ complete this)

The CMVP Board have reviewed this application and met as a board on _____________ to confirm their decision. They have approved / disapproved this application, as presented, for CCCBS Accreditation classification.

________________________ (name) ________________ (signed) _____________ (date)Secretary, EMANZ CCCBS Board

EnergyMasters Continuous Commissioning for Commercial Buildings Specialist Application Form November 2014